Tag: pubmed

Front Oral Health. 2025 Sep 17;6:1539018. doi: 10.3389/froh.2025.1539018. eCollection 2025.

ABSTRACT

INTRODUCTION: Effective pain management techniques are fundamental for enhancing patients’ adherence to various pediatric dental procedures.

OBJECTIVE: This study aims to evaluate the effectiveness of virtual reality (VR) on pain perception during dental procedures in children.

METHODOLOGY: Children aged between 5 and 12 years were recruited from a pediatric dental clinic. Ethical approval and informed consent were obtained from all parents or guardians. The need for different dental procedures was determined for each child based on the outcome of a clinical examination. Some of these procedures require local anesthesia (LA) administration, while others do not. The children were randomly assigned to either a VR or a non-VR group. Three behavioral scales, the Visual Analogue Scale (VAS), the Wong-Baker FACES Pain Rating Scale, and the “Face, Legs, Activity, Cry, and Consolability” (FLACC) Scale, were used to assess the pain level during dental procedures.

RESULTS: A total of 154 children were recruited and evenly divided into VR and non-VR groups (77 each). The results of the study indicated that utilizing VR during dental procedures resulted in a significant reduction in pain perception (p < 0.05) and doubled the level of relaxation experienced by patients (70.31%), irrespective of anesthesia requirements. Statistical analysis revealed a significant difference between the VR and anesthesia groups across all VAS and Wong-Baker FACES variables.

CONCLUSION: This research has confirmed that using virtual reality (VR) as a distraction technique effectively reduces pain during dental procedures for children. VR is a safe, non-invasive, and user-friendly technique that has gained interest as a non-pharmacological option for pain management. As a result, this promising approach has the potential to be used in clinical practice and should be further researched.

PMID:41041487 | PMC:PMC12486600 | DOI:10.3389/froh.2025.1539018

Front Med (Lausanne). 2025 Sep 17;12:1644446. doi: 10.3389/fmed.2025.1644446. eCollection 2025.

ABSTRACT

INTRODUCTION: National Regulatory Authorities have the responsibility of ensuring that pharmaceutical manufacturers comply with Good Manufacturing Practices (GMP) to ensure that medicinal products are consistently produced according to quality standards. Since July 2016, the EAC National Medicines Regulatory Authorities (NRAs) have been collaborating to conduct joint Good Manufacturing Practice (GMP) inspections. This study was conducted to (a) assess the joint GMP inspection procedure, (b) determine key milestones and target timelines, (c) identify areas of improvement and opportunities for capacity building, and (d) identify the contribution of the EAC joint GMP inspections in the operationalization of the African Medicines Agency (AMA).

METHODS: A retrospective review of the timelines for joint GMP inspections conducted from 2016 to 2022 was performed using data recorded in the EAC metric tool. Data is captured based on key milestones, including screening, scheduling joint GMP inspections, planning for joint GMP inspections, conducting physical inspections, reviewing GMP documentation, writing inspection reports, peer reviewing inspection reports, reviewing CAPAs, communicating with applicants, and issuing GMP compliance certificates. JMP was used as the statistical software to analyze the main milestones of the EAC joint GMP inspection process. The study also looked into the twinning model and joint inspections for capacity building among NRAs.

RESULTS: Results indicated that a total of 37 pharmaceutical manufacturing facilities, located in Africa, Asia, and Europe, were jointly inspected (35 physical inspections and two desk reviews) between 2016 and 2022. The inspected facilities manufacture vaccines, non-beta-lactam tablets/capsules, sterile products, and other biologicals. Of the 37 facilities inspected, 65% (24) met EAC GMP standards and received a certificate of compliance, valid for 3 years. 8% (3) of the facilities inspected between 2018 and 2022 failed to meet GMP standards and were advised to apply for reinspection. Two facilities have not submitted corrective and preventive action (CAPA) since 2016, and three facilities have not submitted one since 2022. The study further revealed that one facility is pending joint inspection, one has been awaiting CAPA review since 2019, and one with a CAPA is still under review. Two facilities scheduled for physical inspection in 2020 could not be inspected due to COVID-19 travel restrictions. Timelines for key milestones of the joint GMP inspection process showed that overall scheduling of joint GMP inspections took more than 14 workdays, such as 57 days in 2018, 24 days in 2019, 43 days in 2020, and 28 days in 2022. Median times for planning EAC joint GMP inspections aligned with the set timelines of 30 days; however, in 2017, the median duration was 40 days. All physical inspections conducted between 2016 and 2022 were completed within the median timeline of 3 days. Nonetheless, the median time for GMP report writing in 2016 was 16 days, slightly exceeding the established timeline of 14 days. Findings also indicated that manufacturing facilities (Applicants) take a lengthy time to submit CAPA, which should be done within 90 days. Median submission times for CAPA were 135 days in 2018 and 125 days in 2019. In 2022, notable improvements were observed, with applicants submitting CAPA in a median time of 49 days.

DISCUSSION: EAC GMP inspections have served as a model for building capacity in lessresourced NRAs through the twinning program. The joint inspections are carried out by two inspectors from more experienced National Regulatory Authorities (NRAs) and one inspector from less-resourced NRAs. These NRAs benefit from learning and gaining practical skills, while also building confidence and trust among themselves. This model is suitable for adoption at the continental level by the African Medicines Agency and the African Medicines Regulatory Harmonization Programme to support reliance, convergence, and harmonization. The study identified several gaps, including incomplete data in the metric tool and a lack of monitoring and recording timelines for joint GMP desk assessments. Based on the findings, the EAC region needs to establish an annual planning mechanism for joint GMP inspections and update the metric tool to include key milestones and timelines for the joint GMP desk assessment process. Enhancing the stakeholders’ feedback mechanism is also essential for reducing delays in submitting corrective and preventive actions (CAPA) from facilities and shortening timelines for the joint regulatory inspection process.

PMID:41041458 | PMC:PMC12484000 | DOI:10.3389/fmed.2025.1644446

Front Med (Lausanne). 2025 Sep 17;12:1671323. doi: 10.3389/fmed.2025.1671323. eCollection 2025.

ABSTRACT

BACKGROUND: Red cell distribution width (RDW) has been investigated as a clinical predictor in different study populations. However, its prognostic usefulness in medical and surgical intensive care units remains unknown. This study investigates the role of RDW as a prognostic factor in this specific patient population.

OBJECTIVE: This study examined the relationship between red cell distribution width and other blood parameters as a prognostic indicator among patients treated in medical and surgical ICU.

METHODS: This study is observational in type and its sample consisted of n = 197 patients treated in the medical and surgical ICU (msICU) of a public hospital of Istanbul and during 2023. In this study, personal characteristics (age, gender etc.), clinical characteristics (comorbidity, presence of catheters, length of stay etc.) and clinical/laboratory blood parameters (the RDW coefficient of variation (CV), C reactive protein (CRP), albumin, platelet (PLT) etc.) of msICU patients were analyzed. The relationship between clinical/laboratory parameters was examined using the Pearson correlation test, and changes in RDW values according to patient characteristics were examined using ANOVA and independent sample t-tests.

RESULTS: In this study a positive, strong and statistically significant relationship existed between RDW and lactate (r = 0.704, p = 0.004) and CRP (r = 0.759, p = 0.026), and creatinine (r = 0.729, p = 0.001). It was reported that a negative, weak and statistically significant relationship existed between RDW and albumin (r = -0.172, p = 0.015) and PLT (p = -0.169, p = 0.011). The patient characteristics such as inotropic and vasopressor use, multiple comorbidities, APACHE II score, and surgical experience were factors that increased RDW levels (p < 0.05). Patients in the postoperative period and patients with pressure sores had higher RDW values and these differences were statistically significant (p < 0.05).

CONCLUSION: As a result of this study, RDW level was associated with levels of lactate, CRP, albumin, platelet and creatinine among patients in the medical and surgical ICU. The patients with chronic wounds, comorbidities, and/or certain medications and in deceased patients, were associated with increased RDW. RDW may be a useful marker as a prognostic criterion to validate clinical status.

PMID:41041442 | PMC:PMC12484200 | DOI:10.3389/fmed.2025.1671323

Orthop Rev (Pavia). 2025 Sep 29;17:144737. doi: 10.52965/001c.144737. eCollection 2025.

ABSTRACT

BACKGROUND: Osteogenesis Imperfecta (OI) is a rare genetic bone disorder that has attracted increasing scientific attention. Bibliometric analysis offers insights into the intellectual structure and evolution of this field. This study aimed to identify and evaluate the most highly cited articles on OI to highlight influential contributors, leading journals, and major research trends.

METHODS: A bibliometric search was conducted in the Web of Science Core Collection using the terms “Osteogenesis Imperfecta” and “Brittle Bone Disease.” The search was restricted to English- language original and review articles published between 2000 and 2024. The 50 most cited articles were selected and analyzed based on citation metrics, journal impact factors, author contributions, institutional affiliations, and collaboration patterns. Statistical analyses were performed using SPSS version 25.0.

RESULTS: The United States produced the highest number of publications, followed by the United Kingdom and Germany. The most cited article, published by Rauch et al. (2004), received 950 citations. The Journal of Bone and Mineral Research and The American Journal of Human Genetics were the most prolific journals in this domain. Observational studies and genetic investigations dominated the top-cited works. Collaboration networks revealed strong interconnections among North American and European institutions, while keyword analysis highlighted growing research interest in gene therapy, molecular diagnostics, and precision medicine.

CONCLUSION: This bibliometric analysis identified the most influential contributions in OI research, underscoring the role of key authors, journals, and international collaborations. It also revealed major trends in genetic and clinical studies while highlighting emerging areas such as gene therapy and precision medicine as promising directions for future research.

PMID:41041436 | PMC:PMC12488073 | DOI:10.52965/001c.144737

BMC Med Educ. 2025 Oct 2;25(1):1275. doi: 10.1186/s12909-025-08034-5.

ABSTRACT

BACKGROUND: Competency-based education is globally recognized as the standard for preparing midwives to provide high-quality, evidence-based care. In 2024, Rwanda introduced a standardized, competency-based curriculum for midwifery education aligned with the International Confederation of Midwives (ICM) Essential Competencies. However, the successful implementation of this curriculum depends on the capacity of midwifery educators to deliver it effectively. Understanding faculty development needs is essential for supporting this transition.

AIM: To identify the specific faculty development needs of midwifery educators in Rwanda to inform strategies for strengthening their capacity to deliver competency-based education.

METHOD: A cross-sectional mixed-methods study was conducted in December 2024 using an anonymous online survey. The survey was conducted immediately following the curriculum introduction. Midwifery faculty from all eight institutions offering midwifery education in Rwanda were invited to participate. The survey included Likert-scale and open-ended questions to assess training needs across various educational domains. Quantitative data were analysed using descriptive statistics, and qualitative responses were textually analysed. RESULTS : A total of 48 out of 60 midwifery educators responded. The highest reported needs were in curriculum design and module development (79%), scientific writing (79%), management and leadership (79%), and research skills (77%). Capacity needs were also noted in clinical teaching, particularly using simulation (66%), and in the clinical environment (77%). Faculty expressed preferences for faculty development programs using blended learning with predominantly face-to-face components, and they favored intensive, short-term training formats. CONCLUSION: Midwifery faculty in Rwanda expressed strong needs for capacity development across education, leadership, and research domains. These findings highlight the importance of targeted, context-specific faculty development initiatives. Given the shared challenges across low-resource settings, the findings may be transferable to similar contexts aiming to develop faculty development programs aligned with global standards.

PMID:41039596 | DOI:10.1186/s12909-025-08034-5

BMC Med Educ. 2025 Oct 2;25(1):1329. doi: 10.1186/s12909-025-07909-x.

ABSTRACT

BACKGROUND: Practical classes and skills labs, where students learn, practice, and demonstrate key professional and technical skills, are essential in health professional education. As such, attendance at practical classes has historically been mandated and, in some cases, an “attendance hurdle” (i.e., mandatory minimum attendance requirement that students must meet to pass the course) is applied to subjects where practical classes are a core part of the curriculum. We aimed to explore students’ attitudes, beliefs and experiences of attendance hurdles for practical classes.

METHODS: We surveyed students from entry-to-practice programs in Medicine, Dentistry, Oral Health, Optometry, Physiotherapy, Social Work, Nursing, and Speech Pathology who were currently or previously enrolled in a subject/s with attendance hurdles for practical classes. In a single online survey, students answered multiple-choice, ranking, and Likert questions about their attitudes, beliefs, and experiences of attendance hurdles for practical classes. Data were analysed descriptively and with Pearson chi-squared test of association.

RESULTS: Sixty-three percent (n=362) of 575 students who completed the survey wanted to maintain attendance hurdles. In contrast, almost 80% of students stated they would attend 80% or more of classes without attendance hurdles. Many students believed that attendance hurdles could adversely affect some individuals (e.g., due to personal circumstances and sociodemographics), and half believed as adult learners, they should decide whether to attend practical classes. Students valued the in-class tutor feedback and application to clinical practice that practical classes offered. Students suggested that greater flexibility in the timing of practical classes would be more likely than hurdles to improve attendance.

CONCLUSIONS: The advantages of participating in practical classes to develop essential clinical skills are evident to students, and likely motivate them to attend most scheduled classes. Numerous factors can lead to student absences, and mandating attendance may disadvantage some students. Alternatives to attendance policies could include offering scheduling flexibility and student sign-up, accommodating students’ personal and health needs, and aligning classes to student values.

PMID:41039594 | DOI:10.1186/s12909-025-07909-x

Malar J. 2025 Oct 2;24(1):314. doi: 10.1186/s12936-025-05575-4.

ABSTRACT

BACKGROUND: Malaria in pregnancy (MiP) is responsible for several maternal and neonatal complications. Despite the renewed dedication towards elimination and eradication, it is still endemic in Ghana. Although previous studies have examined MiP from clinical or epidemiological standpoints, gaps remain in understanding the interactions between determinants of transmission. This study examined the synergistic association between environmental, sociocultural, and socioeconomic determinants of MiP.

METHODS: A cross-sectional study was conducted among 456 pregnant women in the Pru East Municipality from April to August 2024. Data were collected using serological screening and a structured, closed-ended questionnaire and were analysed with STATA 17 and IBM SPSS AMOS 29. Descriptive statistics, chi-square tests, logistic regression, confirmatory factor analysis (CFA) and structural equation modelling (SEM) were employed as part of statistical analyses. CFA and SEM were employed to validate multidimensional latent constructs and assess their interdependent and synergistic association within a single analytical framework. A significant level was set at (p < 0.05) at a 95% confidence interval (CI).

RESULTS: Overall, the prevalence of MiP was 21.5% (95% CI 17.7-25.3), with Plasmodium falciparum (14.7%) being the most prevalent species. A co-infection by Plasmodium falciparum and Plasmodium malariae was also found at 3.5%. High Plasmodium parasitaemia was observed in 6.4% of infected women. Moreover, all factor loadings for the three determinants showed significance (p < 0.001) and a high internal consistency. The SEM also yielded good fitness (NFI 0.998, GFI 0.994, AGFI 0.996, CFI 0.984, RMSEA 0.048). Key environmental (proximity to stagnant water, refuse sites, Volta Lake, livestock shelters), sociocultural (spiritual attribution, illness confusion, plant repellents, outdoor sleeping), and socioeconomic (rural residence, delayed ANC initiation, limited media exposure, LLIN use, IPTp-SP uptake, health insurance) factors were strongly associated with MiP. Importantly, the structural model showed that these three domains were moderately to strongly correlated, confirming their synergistic influence on MiP.

CONCLUSION: Malaria control strategies should go beyond biomedical interventions to incorporate community-based environmental management, sociocultural engagement, and socioeconomic empowerment. Such a multidimensional approach is essential to achieving sustainable reductions in malaria burden among vulnerable populations and improving health outcomes.

PMID:41039589 | DOI:10.1186/s12936-025-05575-4

BMC Med Educ. 2025 Oct 2;25(1):1321. doi: 10.1186/s12909-025-07922-0.

ABSTRACT

BACKGROUND: Embryology is often a challenging subject for medical students, leading to decreased engagement and learning difficulties. Gamification has gained attention as an innovative teaching method to enhance motivation and improve educational outcomes. This study examined the impact of gamified embryology education on medical students’ reactions, learning achievements, and behaviors.

METHODS: A quasi-experimental study was conducted with 281 medical students at Jahrom University of Medical Sciences, Iran, from 2020 to 2022. Students in 2020-2021 received conventional instruction through online lectures and electronic content, while those in 2021-2022 were taught using the same routine methods supplemented by a gamification-based platform. Data collection tools included the 18-item Game User Experience Satisfaction Scale (GUESS), the 21-item Technology Acceptance Model (TAM) questionnaire, and a researcher-designed Quality of Online Learning Questionnaire (Q-OLQ). Final exam scores in embryology were compared between the groups. Statistical analysis was performed using SPSS version 21, employing descriptive statistics and Independent Samples t-tests to assess differences in academic performance.

RESULTS: All questionnaire components scored above the threshold, indicating positive responses. The highest satisfaction scores were found in Enjoyment (3.98 ± 1.02) and Visual Aesthetics (3.92 ± 1.04). For technology acceptance, Perceived Usefulness (4.06 ± 0.88), Concentration (3.96 ± 0.83), and Attitude towards Using (3.95 ± 0.90) were rated highly. Regarding online learning quality, Quality of Online Resources (3.95 ± 0.97) and Perceived Importance of Online Resources (3.90 ± 0.99) received the top scores. Importantly, students who experienced gamification alongside routine teaching scored significantly higher on final exams (p < 0.001).

CONCLUSIONS: The findings indicate that gamification effectively enhances student engagement and learning outcomes in medical education, suggesting its valuable role as a complementary teaching strategy.

PMID:41039562 | DOI:10.1186/s12909-025-07922-0

BMC Med Educ. 2025 Oct 2;25(1):1308. doi: 10.1186/s12909-025-07896-z.

ABSTRACT

BACKGROUND: Large Language Models (LLMs) are artificial intelligence (AI) systems that simulate human language processing through deep learning techniques and neural networks. They are increasingly utilized for clinical decision support, student training, and enhancing educational processes. However, the reliability of AI models, especially in answering various types of questions, remains a point of debate. Standard multiple-choice questions (MCQs) involve selecting one correct answer from five options, whereas combination-type MCQs (C-MCQs) identify all correct statements among several alternatives. This study aims to evaluate and compare the performance of various LLMs in answering MCQs and C-MCQs in endodontics.

METHODS: A total of 151 endodontic questions were identified through a comprehensive review of publicly available Dentistry Specialty Exams in Turkey conducted since 2012. The questions were presented to eight LLMs (ChatGPT-4o, ChatGPT-4, Gemini 1.5 Flash, Gemini 1.5 Pro, Gemini 2.0 Flash, Copilot, Deepseek-V3, and Qwen2.5-Max) in Turkish. Accuracy rates for both MCQs and C-MCQs were statistically analyzed using SPSS v23 (p < 0.05).

RESULTS: ChatGPT-4o achieved the highest overall accuracy rate (81.5%), while Gemini 1.5 Flash had the lowest (57%). In standard MCQs, ChatGPT-4o significantly outperformed the other models (p < 0.001), but in C-MCQs, no significant difference was observed between the models (p = 0.179). Across all models, accuracy rates for C-MCQs were significantly lower than for MCQs (p < 0.05). Deepseek-V3 maintained a more balanced performance across question types than the other models.

CONCLUSIONS: LLMs show promising potential as educational tools in endodontics. However, their accuracy varies by question type and model. They can support student learning and clinical decision-making but cannot yet be considered a fully reliable standalone source in endodontics.

PMID:41039560 | DOI:10.1186/s12909-025-07896-z

BMC Med Educ. 2025 Oct 2;25(1):1344. doi: 10.1186/s12909-025-07980-4.

ABSTRACT

BACKGROUND: Vital signs measurement is a fundamental nursing responsibility that requires cognitive and psychomotor competence. In alignment with the ethical principle of nonmaleficence, it is important to provide learning environments where students can practice and make mistakes without causing harm. This study aims to examine the effect of a 3D game-based simulation application developed for vital signs on students’ academic achievement, learning satisfaction and self-confidence levels.

METHODS: A randomized controlled experimental design was employed with 73 nursing students, assigned to either the intervention group (n = 37) or the control group (n = 36). The intervention group used a game-based simulation developed with 3D animation technology, while the control group received traditional instruction. Data were collected using the Student Introductory Characteristics Form, Academic Achievement Test of Vital Signs Measurement Skills, and the Student Satisfaction and Self-Confidence in Learning Scale. Statistical analyses were conducted using SPSS version 25, with significance set at p < 0.05.

RESULTS: The results indicated that students’ current learning satisfaction subscale scores were high in the traditional teaching group and that there was a statistically significant difference between the groups (p = 0.047). There was no statistically significant difference between the groups in terms of academic achievement (p = 0.932) and self-confidence levels in learning (p = 0.375). However, both groups had high mean scores in academic achievement, satisfaction with current learning, and self-confidence in learning.

CONCLUSIONS: The game simulation method supported by 3D animation may be insufficient for significantly improving nursing students’ academic performance, satisfaction with the learning process, and self-confidence in learning. Therefore, it is recommended that such technology-supported methods be used in blended learning environments alongside traditional teaching methods in nursing education.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT07009275; retrospectively registered.

PMID:41039559 | DOI:10.1186/s12909-025-07980-4